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Do we need to go through an agency or can the family hire a private duty home health aide for a disabled person living at home?

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This person is a quadriplegic...total care....all the agency people being sent are toyally unqualified to care for him
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My MIL had in home care paid for by Medicaid. It was from an agency. I don't know if that was a requirement or not. For her it was for 3 hrs a day, 3 days a week for most of the time. Then when she started failing they came and spent the night to give family members a break so they could sleep.
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